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Latorre M, Rizzi A, Paggiaro P, Baiardini I, Bagnasco D, Del Giacco S, Lombardi C, Patella V, Nucera E, Parente R, Paoletti G, Pini L, Ridolo E, Senna G, Blasi F, Canonica GW. Asthma management, focused on the use of oral corticosteroids: the opinions of Italian asthmatic patients. J Asthma 2024:1-12. [PMID: 38578082 DOI: 10.1080/02770903.2024.2338863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 03/31/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVE Patients' perceptions of asthma symptoms, and attitudes regarding diagnosis and management, can affect their ability to reach good asthma control. The aim of the study was to explore patients' perceptions of asthma management, with focus on treatment with oral corticosteroids (OCS). METHODS A DOXAPHARMA survey was conducted. A questionnaire with 46 multiple choice questions was completed by 50 patients with severe uncontrolled asthma, and 258 with mild-moderate controlled or partly controlled asthma. Participants were representative of Italian asthmatic patients-with medium age, long asthma duration, delayed diagnosis, poor asthma control, and frequent exacerbations. RESULTS Many asthmatics reported inadequate pharmacologic treatment. The majority but not all patients regularly used ICS/LABA. Oral treatment was common, mainly with OCS, particularly in severe asthmatics. One-fourth of patients did not regularly use inhaled therapy, and adherence was poor, resulting in frequent OCS use to treat exacerbations, which were common in mild-moderate cases. Patients were fairly satisfied with asthma therapies, but many had concerns about long-term corticosteroid use. Patients complained about poor management of comorbidities associated with asthma and OCS use, but were generally satisfied with their patient/doctor relationships. Many patients failed to achieve optimal health-related quality of life (HRQoL), mainly those with severe asthma who used OCS treatment and emphasized how OCS therapy impacted QoL. CONCLUSIONS The survey results confirmed many problems related to mild-moderate and severe asthma management in Italy and highlighted the overuse of OCS rather than more effective and safe treatments, which had strong negative effects on HRQoL.
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Affiliation(s)
- Manuela Latorre
- Pulmonology Unit, Department of Medical Specialties, Nuovo Ospedale Apuano, Massa, Italy
| | - Angela Rizzi
- UOSD Allergologia e Immunologia Clinica, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | - Pierluigi Paggiaro
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - Ilaria Baiardini
- Respiratory Clinic, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Diego Bagnasco
- Clinica delle Malattie Respiratorie ed Allergologia, IRCCS Policlinico San Martino, Genova, Italy
- Dipartimento di Medicina Interna (DIMI), Università degli Studi di Genova, Genova, Italy
| | - Stefano Del Giacco
- Unit of Allergy and Clinical Immunology, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Carlo Lombardi
- Departmental Unit of Allergology & Respiratory Diseases, Fondazione Poliambulanza, Brescia, Italy
| | - Vincenzo Patella
- Department of Internal and Respiratory Medicine, Division of Allergy and Clinical Immunology, "Santa Maria della Speranza" Hospital, Salerno, Italy
| | - Eleonora Nucera
- UOSD Allergologia e Immunologia Clinica, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
- Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Roberta Parente
- Division of Allergy and Clinical Immunology, Department of Medicine, University of Salerno, Fisciano, Italy
| | - Giovanni Paoletti
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | - Laura Pini
- Department of Clinical and Experimental Sciences, Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Erminia Ridolo
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Gianenrico Senna
- Asthma Center and Allergy Unit, University of Verona and General Hospital, Verona, Italy
| | - Francesco Blasi
- Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Giorgio Walter Canonica
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
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Zewdie S, Bayked EM, Ayenew W, Seyfu A, Andargie A. Prevalence and predictors of medication adherence among adolescents and adults with asthma in Ethiopia: a systematic review and meta-analysis. J Asthma 2024:1-14. [PMID: 38512046 DOI: 10.1080/02770903.2024.2332920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 03/15/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVE This review aimed to estimate the pooled prevalence and predictors of medication adherence among adolescents and adults with asthma in Ethiopia. DATA SOURCES Primary studies were searched from PubMed, Scopus, HINARI, and Google Scholar from January 1, 2010 to December 10, 2023. In addition, we have used citation tracking. STUDY SELECTIONS Observational studies (cross sectional, case control, and cohort) conducted among asthmatic patients ≥15 years old in Ethiopia, published in English language were included. After screening, the studies were assessed using Joanna Briggs Institute (JBI) critical appraisal tool and data were extracted using a checklist. Heterogeneity was assessed using forest plot, Q-statistics and I2. RESULTS The review was performed among 13 institution-based studies with a total of 2901 participants with asthma. About 1058 participants had comorbid disease and 354 were cigarette smokers. The pooled prevalence of adherence to medications among patients with asthma was 40.50% (95% CI: 28.05, 52.96; p value < 0.001) with high heterogeneity (I2 = 98.25%, p < 0.001). Getting health education about asthma and having comorbid disease were predictors of medication adherence among adolescents and adults with asthma in Ethiopia. CONCLUSIONS The pooled prevalence of medication adherence among adolescents and adults with asthma in Ethiopia is low and indicated that three out of five adolescents and adults with asthma were non-adherent to medications. This implies the Ministry of Health should develop different strategies to improve medication adherence including patient education and strengthening the health care system. Multicenter longitudinal studies should be further conducted by using objective methods of adherence measurement and large sample size.
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Affiliation(s)
- Segenet Zewdie
- Department of Pharmacy, Injibara University, Injibara, Ethiopia
| | | | - Wondim Ayenew
- Department of Pharmaceutics, University of Gondar, Gondar, Ethiopia
| | - Abyou Seyfu
- Department of Pharmacy, Debre Birhan University, Debre Birhan, Ethiopia
| | - Assefa Andargie
- Department of Public Health, Injibara University, Injibara, Ethiopia
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Zewdie S, Mekuria B, Alemu BK, Bayked EM, NurAhmed Toleha H, Ayenew W, Andargie A. Prevalence of medication adherence among adult asthmatic patients in four African countries: A systematic review and meta-analysis. World Allergy Organ J 2024; 17:100870. [PMID: 38304621 PMCID: PMC10831257 DOI: 10.1016/j.waojou.2024.100870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 12/29/2023] [Accepted: 01/01/2024] [Indexed: 02/03/2024] Open
Abstract
Non-adherence to medications has many deleterious effects including poor treatment outcomes, increased economic burden, increased morbidity, hospitalization rate, health care utilization, productivity loss, and mortality. Therefore, this review aimed to estimate the pooled prevalence of medication adherence among asthmatic adults in 4 African countries. Primary studies were extensively searched from databases such as PubMed, HINARI, Cochrane Library, CINHALand, Google Scholar, and Google search engines. After screening and assessing the quality of studies, data were extracted using a checklist. Heterogeneity was assessed using forest plot, Chocran's Q Test and I2. The random effects meta-analysis model was employed to pool the prevalence of medication adherence among adult asthmatic patients in Africa. Sub-group analysis and meta-regression were performed to identify the sources of heterogeneity. Publication bias was assessed using funnel plots with Egger's test. A sensitivity analysis was performed to assess the influence of individual studies on the overall estimate. The review was performed among 16 studies of which 14 were cross-sectional with a total of 4019 participants. The pooled random effects prevalence of adherence to medications among adult patients with asthma in Africa was 39% (95% CI: 32, 47; p < 0.001) with a heterogeneity (I2 = 94.82, p < 0.001). The pooled prevalence of medication adherence among adult asthmatic patients in Africa is low. Researchers should conduct further multicenter longitudinal studies by using objective methods of adherence measurement.
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Affiliation(s)
- Segenet Zewdie
- Department of Pharmacy, Injibara University, Injibara, Ethiopia
| | | | | | | | | | - Wondim Ayenew
- Department of Pharmaceutics, University of Gondar, Gondar, Ethiopia
| | - Assefa Andargie
- Department of Public Health, Injibara University, Injibara, Ethiopia
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4
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Prieto-Centurion V, Holm KE, Casaburi R, Porszasz J, Basu S, Bracken NE, Gallardo R, Gonzalez V, Illendula SD, Sandhaus RA, Sullivan JL, Walsh LJ, Gerald LB, Krishnan JA. A Hybrid Effectiveness/Implementation Clinical Trial of Adherence to Long-Term Oxygen Therapy for Chronic Obstructive Pulmonary Disease. Ann Am Thorac Soc 2023; 20:1561-1570. [PMID: 37683098 PMCID: PMC10632931 DOI: 10.1513/annalsats.202302-104oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 09/07/2023] [Indexed: 09/10/2023] Open
Abstract
Rationale: Interventions to promote adherence to long-term oxygen therapy (LTOT) in chronic obstructive pulmonary disease (COPD) are needed. Objectives: To examine the real-world effectiveness of phone-based peer coaching on LTOT adherence and other outcomes in a pragmatic trial of patients with COPD. Methods: In a hybrid effectiveness/implementation pragmatic trial, patients were randomized to receive phone-based proactive coaching (educational materials, five phone-based peer coaching sessions over 60 d), reactive coaching (educational materials, peer coaching when requested), or usual care. Study staff members collected baseline and outcome data via phone at 30, 60, and 90 days after randomization. Adherence to LTOT over 60 days, the primary effectiveness outcome, was defined as mean LTOT use ⩾17.7 h/d. LTOT use was calculated using information about home oxygen equipment use in worksheets completed by study participants. Comparisons of adherence to LTOT between each coaching group and the usual care group using multivariable logistic regression models were prespecified as the primary analyses. Secondary effectiveness outcomes included Patient Reported Outcome Management Information System measures for physical, emotional, and social health. We assessed early implementation domains in the reach, adoption, and implementation framework. Results: In 444 participants, the proportions who were adherent to LTOT at 60 days were 74% in usual care, 84% in reactive coaching, and 70% in proactive coaching groups. Although reach, adoption by stakeholder partners, and intervention fidelity were acceptable, complete LTOT adherence data were available in only 73% of participants. Reactive coaching (adjusted odds ratio, 1.77; 97.5% confidence interval, 0.80-3.90) and proactive coaching (adjusted odds ratio, 0.70; 97.5% confidence interval, 0.34-1.46) did not improve adherence to LTOT compared with usual care. However, proactive coaching significantly reduced depressive symptoms and sleep disturbance compared with usual care and reduced depressive symptoms compared with reactive coaching. Unexpectedly, LTOT adherence was significantly lower in the proactive compared with the reactive coaching group. Conclusions: The results were inconclusive about whether a phone-based peer coaching strategy changed LTOT adherence compared with usual care. Further studies are needed to confirm the potential benefits of proactive peer coaching on secondary effectiveness outcomes and differences in LTOT adherence between proactive and reactive peer coaching. Clinical trial registered with ClinicalTrials.gov (NCT02098369).
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Affiliation(s)
| | - Kristen E. Holm
- Department of Medicine, National Jewish Health, Denver, Colorado
- Department of Community and Behavioral Health, Colorado School of Public Health, Aurora, Colorado
| | - Richard Casaburi
- Lindquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California
| | - Janos Porszasz
- Lindquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California
| | | | - Nina E. Bracken
- Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep and Allergy
- Office of Population Health Sciences, Office of the Vice Chancellor for Health Affairs, University of Illinois Chicago, Chicago, Illinois
| | - Richard Gallardo
- Alzheimer’s Therapeutic Research Institute, San Diego, California
| | - Vanessa Gonzalez
- School of Public Health, and
- American Academy of Sleep Medicine Foundation, Darien, Illinois; and
| | - Sai D. Illendula
- Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep and Allergy
- Office of Population Health Sciences, Office of the Vice Chancellor for Health Affairs, University of Illinois Chicago, Chicago, Illinois
| | | | | | | | - Lynn B. Gerald
- Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep and Allergy
- Office of Population Health Sciences, Office of the Vice Chancellor for Health Affairs, University of Illinois Chicago, Chicago, Illinois
| | - Jerry A. Krishnan
- Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep and Allergy
- Office of Population Health Sciences, Office of the Vice Chancellor for Health Affairs, University of Illinois Chicago, Chicago, Illinois
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5
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Busse WW, Abbott CB, Germain G, Laliberté F, MacKnight SD, Jung Y, Duh MS, Averell CM. Adherence and Persistence to Single-Inhaler Versus Multiple-Inhaler Triple Therapy for Asthma Management. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:2904-2913.e6. [PMID: 35752431 DOI: 10.1016/j.jaip.2022.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 05/23/2022] [Accepted: 06/08/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Treatment guidelines recommend triple therapy for patients with asthma who remain uncontrolled on inhaled corticosteroid/long-acting β2-agonist therapy. Previously, triple therapy was only available via multiple inhalers. Single-inhaler fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) is approved as maintenance treatment for asthma; however, real-world information on adherence and persistence is limited. OBJECTIVE To compare adherence and persistence among adult patients with asthma receiving single-inhaler FF/UMEC/VI versus multiple-inhaler triple therapy (MITT) in the United States. METHODS This retrospective cohort study used IQVIA PharMetrics Plus data to evaluate patients with asthma who initiated once-daily FF/UMEC/VI 100/62.5/25 mcg or MITT between September 18, 2017, and September 30, 2019. Inverse probability weighting and multivariable regression adjusted for differences in characteristics between the FF/UMEC/VI and MITT cohorts. Adherence was assessed using proportion of days covered (PDC) and proportion of patients achieving PDC ≥0.8 and PDC ≥0.5. Non-persistence was identified as a >45-day gap between fills. RESULTS The study included 1396 FF/UMEC/VI and 5115 MITT initiators. Three months after initiation, FF/UMEC/VI users had significantly higher mean PDC versus MITT users (0.68 vs 0.59; P < .001) and 31% more likely to be adherent (PDC ≥0.8; 40.6% vs 31.3%; adjusted risk ratio [95% confidence interval (CI)]: 1.31 [1.13-1.54]; P < .001). Similar patterns were observed at 6 and 12 months post initiation. In addition, FF/UMEC/VI users were 49% more likely to persist at 12 months than MITT users (25.9% vs 15.1%, adjusted hazard ratio [95% CI]: 1.49 [1.39-1.60]; P < .001). CONCLUSIONS Patients with asthma initiating triple therapy with FF/UMEC/VI had significantly better adherence and persistence compared with MITT initiators.
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Affiliation(s)
- William W Busse
- University of Wisconsin School of Medicine and Public Health, Madison, Wisc
| | - Carl B Abbott
- US Medical Affairs, GlaxoSmithKline, Research Triangle Park, NC
| | | | | | | | - Young Jung
- Groupe d'analyse, Ltée, Montréal, QC, Canada
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6
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Backes C, Moyano C, Rimaud C, Bienvenu C, Schneider MP. Digital Medication Adherence Support: Could Healthcare Providers Recommend Mobile Health Apps? FRONTIERS IN MEDICAL TECHNOLOGY 2022; 2:616242. [PMID: 35047896 PMCID: PMC8757821 DOI: 10.3389/fmedt.2020.616242] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 12/29/2020] [Indexed: 11/13/2022] Open
Abstract
Adherence to prescribed medication is suboptimal in 50% of the chronic population, resulting in negative medical and economic outcomes. With the widespread use of mobile phones worldwide, medication adherence apps for mobile phones become promising medication adherence aids thanks to simplicity, user-friendliness, and accessibility for the public. Yet, until today, there is insufficient evidence in favor of using mobile health (mHealth) apps to increase medication adherence. This study aims to develop a methodology for scientific and end-user (patient) mHealth evaluation (a) to identify medication adherence apps search terms, (b) to evaluate identified apps based on scientific criteria, and (c) to report best smartphone apps evaluated by patients. Search terms were identified via literature review and expertise. Firstly, an online questionnaire was developed to identify frequently used search terms by recruited patients. Related medication adherence apps were identified and selected using predefined inclusion criteria. Secondly, identified apps were evaluated thanks to a scientific evaluation method and a created online questionnaire for patient feedback. Recruited patients were invited to test and evaluate the selected apps. Out of 1,833 free-of-charge and 307 paid apps identified, only four free-of-charge and three paid apps remained included in the study after eligibility criteria. None of the selected app reached a high score. Looking at the overall scores, Medisafe (59%), MyTherapy (56%), and Meds on time (44%) received the highest scores in the scientific app evaluation. In the patient evaluation, Dosecast (3.83 out of five points), Medisafe (3.62), and SwissMeds (3.50) received the highest scores. None of the apps in this research has undergone a process for certification, for example, CE marking, through a notified body. Security and data protection aspects of existing apps highly contribute to these low evaluation scores through little information on patient's data processing and storage. This might be corrected through the introduction of General Data Protection Regulation (GDPR) in the European Economic Area (EEA) and more scrutiny through regulatory bodies in the EU/EEA and the USA. None of the applications should be recommended by healthcare providers. In addition, clinical studies with chronic patients are necessary to measure long-term app impacts.
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Affiliation(s)
- Claudine Backes
- Lab of Medication Adherence and Interprofessionality, School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland.,Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland
| | - Carla Moyano
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland
| | - Camille Rimaud
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland
| | - Christine Bienvenu
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Marie P Schneider
- Lab of Medication Adherence and Interprofessionality, School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland.,Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, Geneva, Switzerland.,Pharma24, An Academic Community Pharmacy and Living Lab Located at the Exit of the Geneva University Hospitals, Geneva, Switzerland
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7
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Serhal S, Saini B, Bosnic-Anticevich S, Krass I, Emmerton L, Bereznicki B, Bereznicki L, Mitchell B, Wilson F, Wright B, Wilson K, Weier N, Segrott R, Cleveland R, Jan S, Shan S, Billot L, Armour C. A Targeted Approach to Improve Asthma Control Using Community Pharmacists. Front Pharmacol 2022; 12:798263. [PMID: 35024035 PMCID: PMC8743269 DOI: 10.3389/fphar.2021.798263] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 11/26/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Building on lessons learnt from evidence-based community pharmacy asthma management models, a streamlined and technology supported Pharmacy Asthma Service (PAS) was developed to promote the integration of the service into routine practice. Objective: This study investigates the efficacy of the PAS in improving asthma symptom control and other health outcomes. Methods: A two-arm pragmatic cluster randomized controlled trial was implemented in 95 pharmacies across three Australian States. Participants were adults with poorly controlled asthma as per the Asthma Control Questionnaire (ACQ), with or without allergic rhinitis. Patients within the PAS arm engaged in four consultations with the pharmacist over a 12-month period. An evidence-based algorithm guided pharmacies, via a trial specific software, to deliver a series of interventions targeting three issues underpinning uncontrolled asthma (medication use and adherence, inhaler technique, and allergic rhinitis management) to patient clinical asthma status and patient need. Comparator arm patients received a minimal intervention likened to usual practice involving referral of eligible patients to the GP and two follow-up consultations with their pharmacist to collect comparative data. Results: In total, 143 of 221 PAS patients (65%) and 111 of 160 comparator patients (69%) completed the trial. Improvements in asthma control were achieved in both the PAS (mean difference (MD) in ACQ from baseline = −1.10, p <.0001) and comparator (MD in ACQ from baseline = −0.94, p <.0001) arms at the trial end; however, there were no significant differences between the two arms (MD = −0.16, 95% CI −0.41 to 0.08, p = 0.19). Patients’ quality of life in the PAS arm improved significantly when compared with the comparator arm (MD in Impact of Asthma on Quality-of-Life Questionnaire (IAQLQ) = −0.52, 95% CI −0.89 to −0.14, p = 0.0079). Conclusion: Despite the PAS achieving a greater improvement in patients’ quality of life, the pharmacist-led service and usual practice arm produced comparable improvements in asthma control. These results ask us to reflect on current standards of usual care, as it appears the standard of asthma care in usual practice has evolved beyond what is reported in the literature.
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Affiliation(s)
- Sarah Serhal
- Woolcock Institute of Medical Research, Sydney, NSW, Australia.,School of Pharmacy, The University of Sydney, Sydney, NSW, Australia
| | - Bandana Saini
- Woolcock Institute of Medical Research, Sydney, NSW, Australia.,School of Pharmacy, The University of Sydney, Sydney, NSW, Australia
| | - Sinthia Bosnic-Anticevich
- Woolcock Institute of Medical Research, Sydney, NSW, Australia.,Central Sydney Area Health Service, Sydney, NSW, Australia
| | - Ines Krass
- School of Pharmacy, The University of Sydney, Sydney, NSW, Australia
| | - Lynne Emmerton
- Curtin Medical School, Curtin University, Perth, WA, Australia
| | | | - Luke Bereznicki
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, TAS, Australia
| | | | - Frances Wilson
- Woolcock Institute of Medical Research, Sydney, NSW, Australia
| | - Bronwen Wright
- Curtin Medical School, Curtin University, Perth, WA, Australia
| | - Kiara Wilson
- School of Pharmacy and Pharmacology, University of Tasmania, Hobart, TAS, Australia
| | - Naomi Weier
- The Pharmaceutical Society of Australia, Deakin, ACT, Australia
| | | | - Rhonda Cleveland
- National Asthma Council Australia, South Melbourne, VIC, Australia
| | - Stephen Jan
- The George Institute, Newtown, NSW, Australia.,Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Sana Shan
- The George Institute, Newtown, NSW, Australia
| | - Laurent Billot
- The George Institute, Newtown, NSW, Australia.,Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Carol Armour
- Woolcock Institute of Medical Research, Sydney, NSW, Australia.,Central Sydney Area Health Service, Sydney, NSW, Australia
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8
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Wadhahi AA, Garvey L, Edward KL, Beasley C. The lived experience of adherence to asthma medication in young adults (18-34 years). J Asthma 2021; 59:2475-2490. [PMID: 34902272 DOI: 10.1080/02770903.2021.2018706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Adherence to asthma medications is commonly poor and is the primary cause for anticipated worsening health outcomes for patients with asthma. Worldwide, qualitative investigations that examine the adherence of young adults (18-34 years) to their asthma medication are limited. METHOD This study used a phenomenological research approach to explicate the experience of asthma medication adherence as described by young adults. Data were collected using semi-structured in-depth video interviews conducted with participants aged between 18 and 34 years to elicit their lived experience with adherence to asthma medication. Data from the interviews were transcribed and analyzed using the Edward and Welch (1) extension of Colaizzi's approach to phenomenology. RESULTS Results yielded four main themes related to the phenomenon of adherence that emerged from the analysis. The themes were: Having a plan; Having knowledge about your medication and asthma triggers; Being responsible with asthma medication; and Health belief. CONCLUSION According to the findings, for young people adhering to asthma medication is a process that depends on four vital aspects: (A) plan, (B) knowledge, (C) responsibility, and (D) belief. If young adults with asthma received individualized written asthma plans and have adequate knowledge about this plan, developing the correct health belief is likely to result. Hence, this can lead to a greater responsibility to manage their asthma to the recommended adherence level.
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Affiliation(s)
- Amal Al Wadhahi
- Faculty of Health, Art and Design, Swinburne University of Technology, Melbourne, Australia
| | - Loretta Garvey
- Department of Health Professions, Swinburne University of Technology, Melbourne, Australia
| | - Karen-Leigh Edward
- Faculty of Health, Art and Design, Swinburne University of Technology, Melbourne, Australia.,Swinburne University of Technology, Melbourne, Australia.,School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Carolyn Beasley
- Department of Media and Communication, School of Social Sciences, Media, Film and Education, Swinburne University of Technology, Melbourne, Australia
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9
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Ghaleb Dailah H. Investigating the Outcomes of an Asthma Educational Program and Useful Influence in Public Policy. Front Public Health 2021; 9:736203. [PMID: 34900893 PMCID: PMC8661094 DOI: 10.3389/fpubh.2021.736203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 11/01/2021] [Indexed: 11/13/2022] Open
Abstract
The study was conducted to evaluate the effectiveness of an asthma educational program for asthma control, asthma self-management, asthma knowledge, and patient activation. The study analyzes different demographic variables with the purpose of investigating which asthma patients performed better than others. Based on these demographic characteristics, the study provides several recommendations for various stakeholders. The study is based on a positivist approach since its purpose is to investigate the consequences of an asthma educational program with a view to generalizing the results to a larger population. The study targets public and private hospitals which have applied the asthma educational program in collaboration with the Saudi Initiative for Asthma (SINA). Multiple questionnaires were deployed 263 valid responses were received from patients of public and private hospitals using online and offline data collection method. Several parametric and non-parametric tests were carried out in terms of data analysis. The results reveal that patients in the intervention group obtained high scores and were therefore more knowledgeable and able to control their asthma compared to the control group. Overall, patients in the intervention group performed better in terms of asthma control, asthma self-management and knowledge and awareness. There was a high level of patient activation in this group. In the context of demographic features, it was found that patients who are married and are undergraduate degree holders in employment scored high compared to patients who were young, single, post-graduate degree holders that were mainly self-employed. The results of this study can guide policy makers, SINA authorities, and hospitals as to which demographic category of asthma patients require immediate attention. The significance of asthma educational programmes has increased especially through social media platforms as the number of adult patients continues to increase day by day.
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Khaw SM, Li SC, Mohd Tahir NA. A systematic review of the cost-effectiveness of medicationadherence-enhancing intervention for asthma. J Asthma 2021; 59:697-711. [PMID: 33435775 DOI: 10.1080/02770903.2021.1875483] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Objective: This systematic review aimed to evaluate the cost-effectiveness of medication adherence-improving interventions in patients with asthma.Data source: Search engines including PubMed, Scopus and EBSCOhost were used to locate relevant studies from the inception of the databases to 19 October 2018. Drummond's checklist was used to appraise the quality of the economic evaluation.Study selection: Economic studies evaluating the cost-effectiveness of medication adherence enhancing interventions for asthmatic patients were selected. Relevant information including study characteristics, quality assessment, health outcomes and costs of intervention were narratively summarized. The primary outcome of interest was cost-effectiveness (CE) values and the secondary outcomes were costs, medication adherence and clinical consequences.Results: Twenty studies including 11 randomized controlled trials, 6 comparative studies and 3 modeled studies using Markov models were included in the review. Among these, 15 studies evaluated an educational intervention with 13 showing cost-effectiveness in improving health outcomes. The CE of an internet-based intervention showed similar results between groups, while 3 studies of simplified drug regimens and adding a technology-based training program achieved the desirable cost-effectiveness outcome.Conclusion: Overall, our results would support that all of the identified medication adherence-enhancing interventions were cost-effective considering the increased adherence rate, improved clinical effectiveness and the reduced costs of asthma care. However, it was not possible to identify the most cost-effective intervention. More economic studies with sound methodological conduct will be needed to provide stronger evidence in deciding the best approach to improve medication adherence.
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Affiliation(s)
- Sin Mei Khaw
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala, Lumpur, Malaysia
| | - Shu Chuen Li
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW, Australia
| | - Nurul Ain Mohd Tahir
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala, Lumpur, Malaysia
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11
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Lou Y, Atherly A, Johnson T, Anderson M, Valdez C, Sabalot S. The impact of care management for high-risk pediatric asthmatics on healthcare utilization. J Asthma 2019; 58:133-140. [PMID: 31496315 DOI: 10.1080/02770903.2019.1659311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
INTRODUCTION From 2011 to 2015, a series of quality improvement interventions were developed that targeted pediatric persistent asthmatics that included recalls for those overdue for care and access to specialist care. The objective of this study was to assess the impact on urgent care and emergency department visits and hospitalizations from enrollment into at least one intervention during the time period. METHODS Persistent asthmatics were identified through electronic medical records, with patients having an asthma designation containing "persistent," asthma control containing "poor", and asthma risk being "high risk." Asthma utilization events were identified for these patients between January 1, 2011, and June 30, 2015 using ICD-9 diagnosis codes. Evaluation focused on differences in utilization for patients before and after receiving interventions through the use of logistic regression for each utilization outcome. RESULTS The interventions were delivered to 1060 children out of a total of 2046 identified as having the persistent asthmatic criteria. The intervention group consisted of 389 (36.7%) moderate persistent asthmatics and 643 (60.7%) mild persistent asthmatics, with 976 (92.1%) identifying as a minority. Analysis of 60692 months of data showed patients who received the intervention were less likely to visit the urgent care (OR [0.80, 0.96]) or be hospitalized (OR [0.37, 0.75]) than those who did not receive any interventions. Adjustment for provider referral into the interventions resulted in slight changes for both hospitalizations (OR [0.38, 0.79]) and urgent care (OR [0.68, 0.94]). CONCLUSION Children receiving interventions were less likely to be hospitalized or visit urgent care clinics.
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Affiliation(s)
- Yingbo Lou
- Ambulatory Care Services, Denver Health and Hospital Authority, Denver, CO, USA.,Health Services Research, Colorado School of Public Health, Aurora, CO, USA
| | - Adam Atherly
- The Larner College of Medicine, Center for Health Services Research, Burlington, VT, USA
| | - Tracy Johnson
- Ambulatory Care Services, Denver Health and Hospital Authority, Denver, CO, USA
| | - Mark Anderson
- Ambulatory Care Services, Denver Health and Hospital Authority, Denver, CO, USA
| | - Carolyn Valdez
- Department of Patient Safety and Quality, Denver Health and Hospital Authority, Denver, CO, USA
| | - Sarah Sabalot
- Ambulatory Care Services, Denver Health and Hospital Authority, Denver, CO, USA.,Swedish Primary Care, Swedish Medical Group, Seattle, WA, USA
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Bosnic-Anticevich SZ, Cvetkovski B, Azzi EA, Srour P, Tan R, Kritikos V. Identifying Critical Errors: Addressing Inhaler Technique in the Context of Asthma Management. Pulm Ther 2018; 4:1-12. [PMID: 32026244 PMCID: PMC6966926 DOI: 10.1007/s41030-018-0051-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Indexed: 12/24/2022] Open
Abstract
Medication use has always played a highly significant role in the overall management of asthma, with appropriate use being linked to good asthma control. However, while patients with asthma enjoy the 'luxury' of having medications delivered directly to the lungs via inhaler devices, with that comes the additional challenge of ensuring that inhaler devices are used correctly. Research and practice provides evidence to the challenges associated with inhaler use and the particular steps that patients perform incorrectly. While this problem is well documented, acknowledged and reported, little has changed in 40 years, and the proportion of patients using inhaler devices remains unacceptably high. This review focuses on aspects specific to the errors that patient's make, the significance of these errors, and the important considerations for health care practitioners in supporting patients in correctly using their inhalers. This review highlights the complexities associated with patient's making inhaler technique errors and highlights the opportunities that lie in future technological developments of inhaler devices. Now more than ever, in the era of precision medicine, it is important that we address inhaler technique use once and for all.
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Affiliation(s)
- Sinthia Z Bosnic-Anticevich
- Quality Use of Respiratory Medicines Group, Woolcock Institute, Sydney Medical School, University of Sydney, Sydney, Australia.
- Woolcock Emphysema Centre, University of Sydney, Sydney, Australia.
- Sydney Local Health District, Sydney, Australia.
| | - Biljana Cvetkovski
- Quality Use of Respiratory Medicines Group, Woolcock Institute, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Elizabeth A Azzi
- Quality Use of Respiratory Medicines Group, Woolcock Institute, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Pamela Srour
- Quality Use of Respiratory Medicines Group, Woolcock Institute, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Rachel Tan
- Quality Use of Respiratory Medicines Group, Woolcock Institute, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Vicky Kritikos
- Quality Use of Respiratory Medicines Group, Woolcock Institute, Sydney Medical School, University of Sydney, Sydney, Australia
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, Australia
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13
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Addressing the Impact and Unmet Needs of Nonadherence in Asthma and Chronic Obstructive Pulmonary Disease: Where Do We Go From Here? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2018; 6:785-793. [PMID: 29339126 DOI: 10.1016/j.jaip.2017.11.027] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 11/01/2017] [Accepted: 11/02/2017] [Indexed: 01/08/2023]
Abstract
Nonadherence to treatment, and its associated health and economic burden, is particularly problematic in asthma and chronic obstructive pulmonary disease management because of heterogeneous patient populations and the need for an inhaled route of drug administration. Symptom variability, comorbidities, and device switching further add to suboptimal adherence rates. As opposed to controlled clinical trials, real-life studies show consistently low inhaler adherence in daily practice, yet exact adherence rates have long been affected by disagreement on standardized definitions. The recently developed Ascertaining Barriers to Compliance taxonomy helps to address adherence research disparities by identifying 3 phases of adherence (initiation, implementation [including correct inhaler technique], and discontinuation). This review considers the reasons for and impact of suboptimal adherence, together with summaries of key studies that demonstrate how improving adherence can reduce exacerbations, inhaled corticosteroid use (in cases of better inhaler technique), hospitalizations, and treatment costs. Strategies to help ensure optimal adherence are discussed, including the choice of a patient-tailored inhaler, patient empowerment, education and training, and the potential of electronic monitoring and digital technology. It is concluded that a combined effort from payers, health care professionals, and manufacturers could make a real difference to asthma and chronic obstructive pulmonary disease control, as well as to health care budgets.
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Rodriguez-Martinez CE, Sossa-Briceño MP, Castro-Rodriguez JA. A cost-effectiveness threshold analysis of a multidisciplinary structured educational intervention in pediatric asthma. J Asthma 2017; 55:561-570. [PMID: 28759278 DOI: 10.1080/02770903.2017.1348512] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Asthma educational interventions have been shown to improve several clinically and economically important outcomes. However, these interventions are costly in themselves and could lead to even higher disease costs. A cost-effectiveness threshold analysis would be helpful in determining the threshold value of the cost of educational interventions, leading to these interventions being cost-effective. The aim of the present study was to perform a cost-effectiveness threshold analysis to determine the level at which the cost of a pediatric asthma educational intervention would be cost-effective and cost-saving. METHODS A Markov-type model was developed in order to estimate costs and health outcomes of a simulated cohort of pediatric patients with persistent asthma treated over a 12-month period. Effectiveness parameters were obtained from a single uncontrolled before-and-after study performed with Colombian asthmatic children. Cost data were obtained from official databases provided by the Colombian Ministry of Health. The main outcome was the variable "quality-adjusted life-years" (QALYs). RESULTS A deterministic threshold sensitivity analysis showed that the asthma educational intervention will be cost-saving to the health system if its cost is under US$513.20. Additionally, the analysis showed that the cost of the intervention would have to be below US$967.40 in order to be cost-effective. CONCLUSIONS This study identified the level at which the cost of a pediatric asthma educational intervention will be cost-effective and cost-saving for the health system in Colombia. Our findings could be a useful aid for decision makers in efficiently allocating limited resources when planning asthma educational interventions for pediatric patients.
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Affiliation(s)
- Carlos E Rodriguez-Martinez
- a Department of Pediatrics, School of Medicine , Universidad Nacional de Colombia , Bogota , Colombia.,b Department of Pediatric Pulmonology and Pediatric Critical Care Medicine, School of Medicine , Universidad El Bosque , Bogota , Colombia
| | - Monica P Sossa-Briceño
- c Department of Internal Medicine, School of Medicine , Universidad Nacional de Colombia , Bogota , Colombia
| | - Jose A Castro-Rodriguez
- d Division of Pediatrics, School of Medicine , Pontificia Universidad Catolica de Chile , Santiago , Chile
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15
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Practice makes perfect: self-reported adherence a positive marker of inhaler technique maintenance. NPJ Prim Care Respir Med 2017; 27:29. [PMID: 28439076 PMCID: PMC5435088 DOI: 10.1038/s41533-017-0031-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 03/24/2017] [Accepted: 03/28/2017] [Indexed: 11/08/2022] Open
Abstract
Poor inhaler technique and non-adherence to treatment are major problems in the management of asthma. Patients can be taught how to achieve good inhaler technique, however maintenance remains problematic, with 50% of patients unable to demonstrate correct technique. The aim of this study was to determine the clinical, patient-related and/or device-related factors that predict inhaler technique maintenance. Data from a quality-controlled longitudinal community care dataset was utilized. 238 patients using preventer medications where included. Data consisted of patient demographics, clinical data, medication-related factors and patient-reported outcomes. Mixed effects logistic regression was used to identify predictors of inhaler technique maintenance at 1 month. The variables found to be independently associated with inhaler technique maintenance using logistic regression (Χ 2 (3,n = 238) = 33.24, p < 0.000) were inhaler technique at Visit 1 (OR 7.1), device type (metered dose inhaler and dry powder inhalers) (OR 2.2) and self-reported adherent behavior in the prior 7 days (OR 1.3). This research is the first to unequivocally establish a predictive relationship between inhaler technique maintenance and actual patient adherence, reinforcing the notion that inhaler technique maintenance is more than just a physical skill. Inhaler technique maintenance has an underlying behavioral component, which future studies need to investigate. ASTHMA BEHAVIORAL ELEMENT TO CORRECT LONG-TERM INHALER TECHNIQUES: Patients who consciously make an effort to perfect asthma inhaler technique will maintain their skills long-term. Elizabeth Azzi at the University of Sydney, Australia, and co-workers further add evidence that there is a strong behavioral component to patients retaining correct inhaler technique over time. Poor inhaler technique can limit asthma control, affecting quality of life and increasing the chances of severe exacerbations. Azzi's team followed 238 patients to determine the key predictors of inhaler technique maintenance from factors including age, asthma knowledge and perceived future risks. Correct inhaler technique at initial assessment was the strongest predictor of long-term success, but this was strengthened further when patients reported good adherence to their own medication regimen. This suggests that maintaining correct inhaler technique is more than just a physical skill. Careful guidance towards this 'practice makes perfect' approach may improve patients' long-term technique maintenance.
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Bos AC, Tiddens HAWM, Tong Minh K, Heeres I, Overweel-Uijterlinde JL, Kok AE, Andrinopoulou ER, Janssens HM. Daily Observations of Nebuliser Use and Technique (DONUT) in children with cystic fibrosis. J Cyst Fibros 2016; 15:645-51. [PMID: 27052127 DOI: 10.1016/j.jcf.2016.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 03/04/2016] [Accepted: 03/07/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cystic fibrosis (CF) caregivers focus on correct inhalation technique for nebulisers as this is essential to optimize efficacy of inhaled drugs. However, little is known on this nebuliser technique of patients at home. METHODS Three "hidden" video registrations were made of 32 children with CF (6-18years) nebulising at home. Videos were randomly scored on inhalation technique items using nebuliser-specific checklists and a total score was calculated. RESULTS Median nebuliser technique was 91.9% of max score. Nebuliser technique was perfect (score 100%) in 23.3% of the patients and incorrect (score 0%) in 13.3%. Most mistakes were made in the required optimal breathing pattern. CONCLUSION Most CF patients had good nebuliser technique on a day-to-day basis. However, errors observed likely resulted in reduced treatment efficacy and, in 13%, no treatment at all. Regular "real life" evaluation by the CF-team can improve inhaled therapy substantially.
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Affiliation(s)
- Aukje C Bos
- Department of Paediatric Pulmonology and Allergology, Erasmus Medical Centre (MC)-Sophia Children's Hospital, Wytemaweg 80, 3015CN Rotterdam, The Netherlands.
| | - Harm A W M Tiddens
- Department of Paediatric Pulmonology and Allergology, Erasmus Medical Centre (MC)-Sophia Children's Hospital, Wytemaweg 80, 3015CN Rotterdam, The Netherlands.
| | - Kirby Tong Minh
- Department of Paediatric Pulmonology and Allergology, Erasmus Medical Centre (MC)-Sophia Children's Hospital, Wytemaweg 80, 3015CN Rotterdam, The Netherlands.
| | - Inge Heeres
- Department of Paediatric Pulmonology and Allergology, Erasmus Medical Centre (MC)-Sophia Children's Hospital, Wytemaweg 80, 3015CN Rotterdam, The Netherlands.
| | - Joke L Overweel-Uijterlinde
- Department of Paediatric Pulmonology and Allergology, Erasmus Medical Centre (MC)-Sophia Children's Hospital, Wytemaweg 80, 3015CN Rotterdam, The Netherlands.
| | - Annelies E Kok
- Department of Paediatric Pulmonology and Allergology, Erasmus Medical Centre (MC)-Sophia Children's Hospital, Wytemaweg 80, 3015CN Rotterdam, The Netherlands.
| | | | - Hettie M Janssens
- Department of Paediatric Pulmonology and Allergology, Erasmus Medical Centre (MC)-Sophia Children's Hospital, Wytemaweg 80, 3015CN Rotterdam, The Netherlands.
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Corbella EC. [Research into the education of asthmatic patients: the squaring of the circle]. Aten Primaria 2015; 46:115-6. [PMID: 24629415 PMCID: PMC6983587 DOI: 10.1016/j.aprim.2014.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2013] [Revised: 01/09/2014] [Accepted: 01/12/2014] [Indexed: 12/01/2022] Open
Affiliation(s)
- Eduardo Calvo Corbella
- Miembro del grupo Respiratorio semFYC, Centro de Salud Universitario Pozuelo Estación, Madrid 28224, Pozuelo de Alarcón, Madrid.
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18
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Wechsler ME. Getting control of uncontrolled asthma. Am J Med 2014; 127:1049-1059. [PMID: 24844737 DOI: 10.1016/j.amjmed.2014.05.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Revised: 05/07/2014] [Accepted: 05/08/2014] [Indexed: 10/25/2022]
Abstract
Despite various treatment modalities, a large proportion of patients have asthma that remains uncontrolled. These patients remain at an increased risk of developing severe exacerbations, have a poor quality of life, and pose a high economic healthcare burden, with an estimated mean annual cost more than double that of patients with good symptom control. It is therefore important to accurately diagnose asthma and continually assess asthma control. Several validated tools are available to do this, including questionnaires, biomarker analysis, and bronchoscopy. Current guidelines advise physicians to establish a self-management program for the patient to assess and monitor asthma control. A further recommendation is the establishment of an educational action plan to increase treatment adherence and to improve asthma control. National and international guidelines provide long-term management strategies for these patients and recommend a stepwise approach for achieving and maintaining asthma control. Despite availability of a wide range of controller and reliever therapies, uncontrolled asthma remains a challenge and reflects the need for new therapeutic options. This review discusses current global guidelines for the assessment and management of asthma control and summarizes the broad spectrum of novel therapeutic agents currently under development for the treatment of asthma, including anticholinergics, chemoattractant receptor-homologous molecules expressed on T-helper 2 lymphocyte antagonists, and anti-interleukin (IL)-5, anti-IL-13, and anti-IL-4 agents.
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Shared clinician-patient decision-making about treatment of pediatric asthma: what do we know and how can we use it? Curr Opin Allergy Clin Immunol 2014; 14:161-7. [PMID: 24553296 DOI: 10.1097/aci.0000000000000046] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Shared decision-making (SDM) is an emerging field that promises to improve healthcare. We aim to explore the concept of SDM, how it has been studied or applied in the treatment of asthma, and how it might be implemented to improve adherence and outcomes in pediatric asthma. RECENT FINDINGS Healthcare providers often fail to involve their patients in clinical decision-making by not presenting all available options, associated risks and benefits, in light of the patient's values, preferences, concerns, lifestyle, and perceived barriers to following various treatment regimens. It has been argued that SDM is preferable to a clinician-controlled approach and may improve patient outcomes (increase satisfaction with care, reduce decisional conflict and decisional regret, improve health-related quality of life, and increase decision-specific knowledge). This may be especially important in managing chronic conditions in which adherence to treatment regimen may increase if the patient was actively involved in the decision-making. In pediatrics, the decision process is further complicated by the clinician-parent(s)-child interaction. We found no studies on how to effectively involve and communicate with children at different developmental levels, or how to coalesce the parent and child's perspective to work as a unit. SUMMARY SDM has the promise to improve satisfaction with disease management, treatment adherence and patient-centered outcomes in pediatric asthma, but further research is needed to determine its effectiveness and to establish guidelines on how to implement SDM in the clinical setting and incorporate the input and preferences of all stakeholders' perspectives.
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Zafari Z, Lynd LD, FitzGerald JM, Sadatsafavi M. Economic and health effect of full adherence to controller therapy in adults with uncontrolled asthma: a simulation study. J Allergy Clin Immunol 2014; 134:908-915.e3. [PMID: 24875619 DOI: 10.1016/j.jaci.2014.04.009] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 04/10/2014] [Accepted: 04/14/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Adherence to evidence-based controller treatments for asthma is disappointingly low in many jurisdictions. Quantifying the burden associated with suboptimal adherence in patients with uncontrolled asthma will help establish the priorities for policymakers. OBJECTIVE We sought to quantify the benefits in the United States of improving adherence to controller therapies in adults with uncontrolled asthma in terms of health care costs and quality-adjusted life years (QALYs). METHODS A Markov model of asthma was created to simulate the effect of treatment with controller medications on asthma control and exacerbations over a 10-year time horizon. Health care costs and QALYs associated with the current level of adherence (status quo) were compared with a hypothetical scenario in which each patient with uncontrolled asthma at baseline will be fully adherent to an evidence-based controller therapy (the full-adherence scenario). We also evaluated the cost-effectiveness of adherence interventions as a function of their costs and improvement in the adherence. RESULTS The status quo level of asthma management was associated with $2,786 costs and 7.55 QALYs over 10 years, whereas the corresponding values for the full-adherence scenario were $5,973 and 7.68, respectively. Consequently, the incremental cost-effectiveness ratio of the full-adherence versus the status quo was $24,515/QALY. To be cost-effective, a program that improves adherence by 50% should cost less than $130 ($450) per person annually at a willingness-to-pay value of $50,000/QALY ($100,000/QALY). Inclusion of productivity loss in the analysis resulted in the full-adherence scenario being cost-saving. CONCLUSION Considering the extent of suboptimal adherence, our study shows that attempts in improving adherence to evidence-based therapies in patients with uncontrolled asthma can be associated with significant return on investment.
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Affiliation(s)
- Zafar Zafari
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Institute, Vancouver, British Columbia, Canada
| | - Larry D Lynd
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Health Evaluation and Outcomes Sciences, Providence Health Research Institute, Vancouver, British Columbia, Canada
| | - J Mark FitzGerald
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Institute, Vancouver, British Columbia, Canada; Institute for Heart and Lung Health (IHLH), Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mohsen Sadatsafavi
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Institute, Vancouver, British Columbia, Canada; Institute for Heart and Lung Health (IHLH), Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
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Wheeler KJ, Roberts ME, Neiheisel MB. Medication adherence part two: predictors of nonadherence and adherence. J Am Assoc Nurse Pract 2014; 26:225-232. [PMID: 24574102 DOI: 10.1002/2327-6924.12105] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE This is the second of a three-part series on medication adherence in which the authors describe the continuum of adherence to nonadherence of medication usage. DATA SOURCES Research articles through MEDLINE and PubMed. CONCLUSIONS Understanding the magnitude and scope of the problem of medication nonadherence is the first step in reaching better adherence rates (described in Part One of this series). The second step is to recognize the complexities of the reasons for medication adherence/nonadherence (described here). Reasons for nonadherence include beliefs related to the benefits of medication for physical and mental disorders, complexities of systems of health care and treatment plans, and lifestyle and demographic characteristics of patients. The final step is to evaluate each patient for medication adherence, tailoring the plan of care according to patient and system specific barriers (described in Part Three of this series). IMPLICATIONS FOR PRACTICE Nurse practitioners must recognize a critical element of thorough care is to assess medication adherence at each patient visit, countering patient and system barriers as indicated. Nurse practitioners also need to adjust assessment and prescribing practices according to the evidence for best practices to improve medication adherence.
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Affiliation(s)
- Kathy J Wheeler
- University of Kentucky College of Nursing, Lexington, Kentucky, Seton Hall University, South Orange, New Jersey, University of Louisiana at Lafayette, Lafayette, Louisiana
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Shin YS, Park HS. Is it possible to achieve better asthma control by using the same inhaler device? ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2012; 4:169-70. [PMID: 22754708 PMCID: PMC3378921 DOI: 10.4168/aair.2012.4.4.169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Accepted: 04/30/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Yoo Seob Shin
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
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